| NPI | 1851602338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: VT 0031117) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: NY 008599) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2012-06-05 |